|
EKG SUBQU SAME DR
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
8026969
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$72.45 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna of IA Commercial |
$144.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.90
|
| Rate for Payer: Aetna of IA Medicare |
$91.77
|
| Rate for Payer: Amerigroup Medicaid |
$92.86
|
| Rate for Payer: Amerigroup Medicare |
$73.17
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$72.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$91.96
|
| Rate for Payer: Medical Associates Commercial |
$120.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$72.45
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$93.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$83.32
|
| Rate for Payer: United Healthcare Commercial |
$144.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$94.99
|
|
|
EKG SUBSQ DIFF DR
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
8026970
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$112.70 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna of IA Commercial |
$144.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.90
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.75
|
| Rate for Payer: Medical Associates Commercial |
$120.75
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: United Healthcare Commercial |
$144.90
|
|
|
EKG SUBSQ DIFF DR
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
8026970
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$72.45 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Aetna of IA Commercial |
$144.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$144.90
|
| Rate for Payer: Aetna of IA Medicare |
$91.77
|
| Rate for Payer: Amerigroup Medicaid |
$92.86
|
| Rate for Payer: Amerigroup Medicare |
$73.17
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$120.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$72.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$91.96
|
| Rate for Payer: Medical Associates Commercial |
$120.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$72.45
|
| Rate for Payer: Midlands Choice Commercial |
$112.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$93.32
|
| Rate for Payer: Partners Health Alliance Commercial |
$83.32
|
| Rate for Payer: United Healthcare Commercial |
$144.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$94.99
|
|
|
ELEC STIM MAN 15 MIN
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 97032 GP
|
| Hospital Charge Code |
1374009
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$54.45 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Aetna of IA Commercial |
$108.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$108.90
|
| Rate for Payer: Aetna of IA Medicare |
$68.97
|
| Rate for Payer: Amerigroup Medicaid |
$69.79
|
| Rate for Payer: Amerigroup Medicare |
$54.99
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$90.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$54.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.12
|
| Rate for Payer: Medical Associates Commercial |
$90.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$54.45
|
| Rate for Payer: Midlands Choice Commercial |
$84.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.13
|
| Rate for Payer: Partners Health Alliance Commercial |
$62.62
|
| Rate for Payer: United Healthcare Commercial |
$108.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$71.39
|
|
|
ELEC STIM MAN 15 MIN
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 97032 GP
|
| Hospital Charge Code |
1374009
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$84.70 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Aetna of IA Commercial |
$108.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$108.90
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$90.75
|
| Rate for Payer: Medical Associates Commercial |
$90.75
|
| Rate for Payer: Midlands Choice Commercial |
$84.70
|
| Rate for Payer: United Healthcare Commercial |
$108.90
|
|
|
ELECTROLYTES
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
633610
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$38.70 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Aetna of IA Commercial |
$77.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$77.40
|
| Rate for Payer: Aetna of IA Medicare |
$49.02
|
| Rate for Payer: Amerigroup Medicaid |
$49.60
|
| Rate for Payer: Amerigroup Medicare |
$39.09
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$64.50
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$38.70
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$49.12
|
| Rate for Payer: Medical Associates Commercial |
$64.50
|
| Rate for Payer: Medical Associates Managed Medicare |
$38.70
|
| Rate for Payer: Midlands Choice Commercial |
$60.20
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$49.85
|
| Rate for Payer: Partners Health Alliance Commercial |
$44.51
|
| Rate for Payer: United Healthcare Commercial |
$77.40
|
| Rate for Payer: United Healthcare Managed Medicare |
$50.74
|
|
|
ELECTROLYTES
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
633610
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Aetna of IA Commercial |
$77.40
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$77.40
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$64.50
|
| Rate for Payer: Medical Associates Commercial |
$64.50
|
| Rate for Payer: Midlands Choice Commercial |
$60.20
|
| Rate for Payer: United Healthcare Commercial |
$77.40
|
|
|
ELECT STIM MANUAL PER 15 MIN
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 97032 GO
|
| Hospital Charge Code |
1373442
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$54.45 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Aetna of IA Commercial |
$108.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$108.90
|
| Rate for Payer: Aetna of IA Medicare |
$68.97
|
| Rate for Payer: Amerigroup Medicaid |
$69.79
|
| Rate for Payer: Amerigroup Medicare |
$54.99
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$90.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$54.45
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$69.12
|
| Rate for Payer: Medical Associates Commercial |
$90.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$54.45
|
| Rate for Payer: Midlands Choice Commercial |
$84.70
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$70.13
|
| Rate for Payer: Partners Health Alliance Commercial |
$62.62
|
| Rate for Payer: United Healthcare Commercial |
$108.90
|
| Rate for Payer: United Healthcare Managed Medicare |
$71.39
|
|
|
ELECT STIM MANUAL PER 15 MIN
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 97032 GO
|
| Hospital Charge Code |
1373442
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$84.70 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Aetna of IA Commercial |
$108.90
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$108.90
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$90.75
|
| Rate for Payer: Medical Associates Commercial |
$90.75
|
| Rate for Payer: Midlands Choice Commercial |
$84.70
|
| Rate for Payer: United Healthcare Commercial |
$108.90
|
|
|
EMERGENCY INTUBATION
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
8059060
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$128.25 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna of IA Commercial |
$256.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$256.50
|
| Rate for Payer: Aetna of IA Medicare |
$162.45
|
| Rate for Payer: Amerigroup Medicaid |
$164.39
|
| Rate for Payer: Amerigroup Medicare |
$129.53
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$213.75
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$128.25
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$162.79
|
| Rate for Payer: Medical Associates Commercial |
$213.75
|
| Rate for Payer: Medical Associates Managed Medicare |
$128.25
|
| Rate for Payer: Midlands Choice Commercial |
$199.50
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$165.19
|
| Rate for Payer: Partners Health Alliance Commercial |
$147.49
|
| Rate for Payer: United Healthcare Commercial |
$256.50
|
|
|
EMERGENCY INTUBATION
|
Facility
|
OP
|
$488.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
5338936
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$219.60 |
| Max. Negotiated Rate |
$439.20 |
| Rate for Payer: Aetna of IA Commercial |
$439.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$439.20
|
| Rate for Payer: Aetna of IA Medicare |
$278.16
|
| Rate for Payer: Amerigroup Medicaid |
$281.48
|
| Rate for Payer: Amerigroup Medicare |
$221.80
|
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$366.00
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$219.60
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$278.75
|
| Rate for Payer: Medical Associates Commercial |
$366.00
|
| Rate for Payer: Medical Associates Managed Medicare |
$219.60
|
| Rate for Payer: Midlands Choice Commercial |
$341.60
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$282.84
|
| Rate for Payer: Partners Health Alliance Commercial |
$252.54
|
| Rate for Payer: United Healthcare Commercial |
$439.20
|
| Rate for Payer: United Healthcare Managed Medicare |
$287.92
|
|
|
EMERGENCY INTUBATION
|
Professional
|
Both
|
$483.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
8059060
|
|
Hospital Revenue Code
|
975
|
| Min. Negotiated Rate |
$220.94 |
| Max. Negotiated Rate |
$362.25 |
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Medical Associates Commercial |
$362.25
|
| Rate for Payer: Midlands Choice Commercial |
$338.10
|
| Rate for Payer: Partners Health Alliance Commercial |
$362.25
|
| Rate for Payer: United Healthcare Commercial |
$220.94
|
|
|
EMERGENCY INTUBATION
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
8059060
|
|
Hospital Revenue Code
|
964
|
| Min. Negotiated Rate |
$199.50 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna of IA Commercial |
$256.50
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$256.50
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$213.75
|
| Rate for Payer: Medical Associates Commercial |
$213.75
|
| Rate for Payer: Midlands Choice Commercial |
$199.50
|
| Rate for Payer: United Healthcare Commercial |
$256.50
|
|
|
EMERGENCY INTUBATION
|
Facility
|
IP
|
$488.00
|
|
|
Service Code
|
CPT 31500
|
| Hospital Charge Code |
5338936
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$341.60 |
| Max. Negotiated Rate |
$439.20 |
| Rate for Payer: Aetna of IA Commercial |
$439.20
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$439.20
|
| Rate for Payer: Cash Price |
$390.40
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$366.00
|
| Rate for Payer: Medical Associates Commercial |
$366.00
|
| Rate for Payer: Midlands Choice Commercial |
$341.60
|
| Rate for Payer: United Healthcare Commercial |
$439.20
|
|
|
emollients, topical - Cre [VDMC]
|
Facility
|
IP
|
$27.52
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11222638
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$19.27 |
| Max. Negotiated Rate |
$24.77 |
| Rate for Payer: Aetna of IA Commercial |
$24.77
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.77
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.64
|
| Rate for Payer: Medical Associates Commercial |
$20.64
|
| Rate for Payer: Midlands Choice Commercial |
$19.27
|
| Rate for Payer: United Healthcare Commercial |
$24.77
|
|
|
emollients, topical - Cre [VDMC]
|
Facility
|
OP
|
$27.52
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
11222638
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$24.77 |
| Rate for Payer: Aetna of IA Commercial |
$24.77
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$24.77
|
| Rate for Payer: Aetna of IA Medicare |
$15.69
|
| Rate for Payer: Amerigroup Medicaid |
$15.87
|
| Rate for Payer: Amerigroup Medicare |
$12.51
|
| Rate for Payer: Cash Price |
$22.02
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$20.64
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$12.38
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$15.72
|
| Rate for Payer: Medical Associates Commercial |
$20.64
|
| Rate for Payer: Medical Associates Managed Medicare |
$12.38
|
| Rate for Payer: Midlands Choice Commercial |
$19.27
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$15.95
|
| Rate for Payer: Partners Health Alliance Commercial |
$14.24
|
| Rate for Payer: United Healthcare Commercial |
$24.77
|
| Rate for Payer: United Healthcare Managed Medicare |
$16.24
|
|
|
empagliflozin 10 mg Tab [VDMC]
|
Facility
|
IP
|
$51.95
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
16938348
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$36.36 |
| Max. Negotiated Rate |
$46.75 |
| Rate for Payer: Aetna of IA Commercial |
$46.75
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$46.75
|
| Rate for Payer: Cash Price |
$41.56
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.96
|
| Rate for Payer: Medical Associates Commercial |
$38.96
|
| Rate for Payer: Midlands Choice Commercial |
$36.36
|
| Rate for Payer: United Healthcare Commercial |
$46.75
|
|
|
empagliflozin 10 mg Tab [VDMC]
|
Facility
|
OP
|
$51.95
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
16938348
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$23.38 |
| Max. Negotiated Rate |
$46.75 |
| Rate for Payer: Aetna of IA Commercial |
$46.75
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$46.75
|
| Rate for Payer: Aetna of IA Medicare |
$29.61
|
| Rate for Payer: Amerigroup Medicaid |
$29.96
|
| Rate for Payer: Amerigroup Medicare |
$23.61
|
| Rate for Payer: Cash Price |
$41.56
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.96
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$23.38
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.67
|
| Rate for Payer: Medical Associates Commercial |
$38.96
|
| Rate for Payer: Medical Associates Managed Medicare |
$23.38
|
| Rate for Payer: Midlands Choice Commercial |
$36.36
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$26.88
|
| Rate for Payer: United Healthcare Commercial |
$46.75
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.65
|
|
|
empagliflozin 25 mg Tab UD [VDMC]
|
Facility
|
OP
|
$51.95
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
23268393
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$23.38 |
| Max. Negotiated Rate |
$46.75 |
| Rate for Payer: Aetna of IA Commercial |
$46.75
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$46.75
|
| Rate for Payer: Aetna of IA Medicare |
$29.61
|
| Rate for Payer: Amerigroup Medicaid |
$29.96
|
| Rate for Payer: Amerigroup Medicare |
$23.61
|
| Rate for Payer: Cash Price |
$41.56
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.96
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$23.38
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$29.67
|
| Rate for Payer: Medical Associates Commercial |
$38.96
|
| Rate for Payer: Medical Associates Managed Medicare |
$23.38
|
| Rate for Payer: Midlands Choice Commercial |
$36.36
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$30.11
|
| Rate for Payer: Partners Health Alliance Commercial |
$26.88
|
| Rate for Payer: United Healthcare Commercial |
$46.75
|
| Rate for Payer: United Healthcare Managed Medicare |
$30.65
|
|
|
empagliflozin 25 mg Tab UD [VDMC]
|
Facility
|
IP
|
$51.95
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
23268393
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$36.36 |
| Max. Negotiated Rate |
$46.75 |
| Rate for Payer: Aetna of IA Commercial |
$46.75
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$46.75
|
| Rate for Payer: Cash Price |
$41.56
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$38.96
|
| Rate for Payer: Medical Associates Commercial |
$38.96
|
| Rate for Payer: Midlands Choice Commercial |
$36.36
|
| Rate for Payer: United Healthcare Commercial |
$46.75
|
|
|
enalaprilat 1.25 mg/mL 1ml SDV [VDMC]
|
Facility
|
OP
|
$34.39
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10385557
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$15.47 |
| Max. Negotiated Rate |
$30.95 |
| Rate for Payer: Aetna of IA Commercial |
$30.95
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$30.95
|
| Rate for Payer: Aetna of IA Medicare |
$19.60
|
| Rate for Payer: Amerigroup Medicaid |
$19.83
|
| Rate for Payer: Amerigroup Medicare |
$15.63
|
| Rate for Payer: Cash Price |
$27.51
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25.79
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$15.47
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$19.64
|
| Rate for Payer: Medical Associates Commercial |
$25.79
|
| Rate for Payer: Medical Associates Managed Medicare |
$15.47
|
| Rate for Payer: Midlands Choice Commercial |
$24.07
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$19.93
|
| Rate for Payer: Partners Health Alliance Commercial |
$17.80
|
| Rate for Payer: United Healthcare Commercial |
$30.95
|
| Rate for Payer: United Healthcare Managed Medicare |
$20.29
|
|
|
enalaprilat 1.25 mg/mL 1ml SDV [VDMC]
|
Facility
|
IP
|
$34.39
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
10385557
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$30.95 |
| Rate for Payer: Aetna of IA Commercial |
$30.95
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$30.95
|
| Rate for Payer: Cash Price |
$27.51
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$25.79
|
| Rate for Payer: Medical Associates Commercial |
$25.79
|
| Rate for Payer: Midlands Choice Commercial |
$24.07
|
| Rate for Payer: United Healthcare Commercial |
$30.95
|
|
|
enalapril maleate 5 mg Tab [VDMC]
|
Facility
|
OP
|
$1.18
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10431638
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Aetna of IA Commercial |
$1.06
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.06
|
| Rate for Payer: Aetna of IA Medicare |
$0.67
|
| Rate for Payer: Amerigroup Medicaid |
$0.68
|
| Rate for Payer: Amerigroup Medicare |
$0.54
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.89
|
| Rate for Payer: Humana of IA Commercial PPO (non PPOx)/Medicare Advantage HMO/Medicare Advantage PPO/PFFS |
$0.53
|
| Rate for Payer: Iowa Total Care Managed Medicaid |
$0.68
|
| Rate for Payer: Medical Associates Commercial |
$0.89
|
| Rate for Payer: Medical Associates Managed Medicare |
$0.53
|
| Rate for Payer: Midlands Choice Commercial |
$0.83
|
| Rate for Payer: Molina Healthcare Managed Medicaid |
$0.69
|
| Rate for Payer: Partners Health Alliance Commercial |
$0.61
|
| Rate for Payer: United Healthcare Commercial |
$1.06
|
| Rate for Payer: United Healthcare Managed Medicare |
$0.70
|
|
|
enalapril maleate 5 mg Tab [VDMC]
|
Facility
|
IP
|
$1.18
|
|
|
Service Code
|
HCPCS A9270
|
| Hospital Charge Code |
10431638
|
|
Hospital Revenue Code
|
259
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$1.06 |
| Rate for Payer: Aetna of IA Commercial |
$1.06
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$1.06
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$0.89
|
| Rate for Payer: Medical Associates Commercial |
$0.89
|
| Rate for Payer: Midlands Choice Commercial |
$0.83
|
| Rate for Payer: United Healthcare Commercial |
$1.06
|
|
|
ENDO CLIP CARTRIDGE
|
Facility
|
IP
|
$94.00
|
|
| Hospital Charge Code |
8026309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Aetna of IA Commercial |
$84.60
|
| Rate for Payer: Aetna of IA Medical Rental Products |
$84.60
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Health Alliance-Midwest, Inc. of IA Commercial |
$70.50
|
| Rate for Payer: Medical Associates Commercial |
$70.50
|
| Rate for Payer: Midlands Choice Commercial |
$65.80
|
| Rate for Payer: United Healthcare Commercial |
$84.60
|
|
